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Published on: April 28, 2020
[Paracetamol poisoning--occurrence and treatment]
1Akuttmedisinsk avdeling, Medisinsk divisjon, Ullevål universitetssykehus, 0407 Oslo. rune.aakvik@ulleval.no
Summary
Paracetamol poisoning is common, but early N-acetyl cysteine treatment effectively prevents liver damage. Delayed hospital admission beyond 15 hours significantly increases the risk of liver injury and death from paracetamol overdose.
Area of Science:
- Toxicology
- Pharmacology
- Clinical Medicine
Context:
- Paracetamol (acetaminophen) poisoning represents a significant public health concern due to its frequency and potential for severe hepatotoxicity.
- Effective management relies on timely administration of the antidote N-acetyl cysteine (NAC) and monitoring via serum paracetamol levels.
Purpose:
- To evaluate the incidence of paracetamol poisoning within a hospital setting.
- To assess the utilization and efficacy of serum paracetamol analyses in guiding N-acetyl cysteine (NAC) treatment.
- To identify factors associated with the development of liver damage and mortality.
Summary:
- A retrospective review of 869 acute poisoning admissions identified 158 cases (21%) due to paracetamol, predominantly in women (76%).
- N-acetyl cysteine (NAC) was administered to 107 patients (68%) based on suspected high-dose ingestion, but treatment was discontinued in 79% due to serum levels falling below the treatment nomogram threshold.
- Liver damage (ALT > 1,000 U/l) occurred in 6% of patients, all presenting more than 15 hours post-ingestion. One fatality was recorded.
Impact:
- This study underscores the importance of early presentation for paracetamol poisoning management.
- Timely initiation of N-acetyl cysteine (NAC) appears to be a crucial factor in preventing hepatotoxicity.
- Delayed treatment is strongly correlated with adverse outcomes, including liver damage and mortality, highlighting the need for prompt medical attention.
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